Spigelian Hernia

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Findings: Figures 1, 2 and 3. Figure 1 is a sagittal reconstruction demonstrating a small bowel loop extending into a small hernia sac in the anterior abdominal wall, closed arrow. Figure 2 is a coronal reconstruction demonstrating the same LEFT lateral anterior abdominal wall hernia with small bowel extending into the hernia sac, closed arrow. Figure 3 is the axial image demonstrating a hernia extending through the LEFT lateral abdominal wall at the lateral margin of the rectus muscle and the lateral abdominal musculature, closed arrow. Also demonstrated on Figures 2 and 3 are segments of dilated small bowel, curved arrow.

Diagnosis: Spigelian hernia with incarcerated small bowel loop and small bowel obstruction.

Information:

Spigelian hernias are uncommon hernias of the anterior abdominal wall occurring along the lateral margin of the rectus abdominis muscle through a defect in the linea semilunaris, which is the aponeurosis of the internal oblique and transverse abdominal muscles.

Spigelian hernias usually occur in patients who are

1. Multiparous woman with recent weight loss

2. As a result of increased intra-abdominal pressure secondary to heavy lifting, urinary retention, COPD or gastric obstruction

3. Obesity

4. Prior surgery

5. Peritoneal dialysis

6. Congenital

The differential diagnosis depends on the side of herniation but includes: Appendicitis, bowel obstruction, diverticulitis, colitis and rectus muscle hematomas.

Treatment is either by open surgical technique or laparoscopy. All hernias should be treated due to their risk of incarceration, bowel obstruction and strangulation.

References:

Diagnosis and management of Spigelian hernia: A review of literature and our experience.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699222

Spigelian, Grynfeltt, and Petit Hernia.

http://www.med-ed.virginia.edu/courses/rad/gi/hernias/Spiggrynpet.html

 

 

 

 

 

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Epidural Hematoma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Findings: Figures 1, 2 and 3: Figures 1 and 2 demonstrate a fracture involving the RIGHT orbital roof and extending into the adjacent calvarium, straight arrow. Figure 3 demonstrates high density with mass effect in the RIGHT frontal area.

Diagnosis: Fracture in the RIGHT skull base and extending to the calvarium with an associated epidural hematoma.

Information:

  1. Epidural hematomas are most frequently associated with skull fractures. The most common is fracture in the temporal region with disruption of the middle meningeal artery.
  2. Epidural hematomas are much more common in young people due to the looser attachment of the dura as compared to older adults.
  3. The classic symptoms for an epidural hematoma include immediate loss of consciousness secondary to the initial trauma. On awakening, the patient experiences various degrees of alertness. This is followed by a second loss of consciousness. The second loss of consciousness is due to the accumulating blood and mass effect on the adjacent brain.
  4. Up to 20% of epidural hematomas will result in fatality.
  5. CT:
  1. Hemorrhages are frequently associated with fractures.
  2. Biconvex appearance to the hemorrhage is typical.

 

 

 

 

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Radiology case: Fat within the sagittal sinus (AKA pseudo-delta sign)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Findings: Figure 1 and Figure 2. CT scans of the head. Within the anterior central portion of the superior sagittal sinus there is an area of low attenuation. Figure 2 demonstrates this to have a mean density of 0.

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Radiology case: Subdural hematoma

Findings:
Figure 1. CT Scan of the head demonstrating right-sided subdural hematoma, solid arrow.  This is a complex subdural hematoma with layering. This can be seen in patients who have been in a particular position, in this case supine, for extended period of time following the onset of a subdural hematoma. The more anterior components of this subdural are isodense with the adjacent brain. Note also that there is extensive low attenuation throughout the RIGHT cerebral hemisphere and LEFT frontal area consistent with extensive ischemia. There is also a small component of interhemispheric subdural hematoma anteriorly.

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Radiology case: Ovarian torsion


Findings: Figures 1 through 5 are axial images of a CT scan performed with contrast. The examination demonstrates a RIGHT pelvic mass which is inhomogeneous. There are areas of focal decreased density peripherally with a more focal central low density also demonstrated. NO free fluid.

Figures 6 through 8 are ultrasound studies of the same patient. Figure 6 demonstrates a mass with peripheral areas of decreased echogenicity. Figures 7 and 8 are Doppler studies which demonstrate minimal Doppler flow within the tissues around the margins of the mass but NO evidence of Doppler flow within the mass.

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Radiology case: Duodenitis Ulcer

Findings in this case: Figures 1 through 4.  Figures 1, 2 and 3, axial images of the upper abdomen demonstrating thickened and distended duodenum (straight white arrow), extravasation (thin black arrow) and blood in the right paracolic gutter (curved arrow).

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Radiology case: Trichothiodystrophy

Findings: Figures 1 and 2. AP views of the chest demonstrating diffusely sclerotic bones. There is also thickening of the ribs.

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Radiology Case: Colon Carcinoma

Findings in this case: There is moderate focal thickening of the colonic wall in the ascending segment (arrows).

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Radiology Case: Happy Halloween

Findings: Figures 1 through 3. Figure 1 is a CT scan of the pelvis. A ghostly face appears from under pubis symphysis. While the femoral neck areas are normal in this patient, it was one said that we entered life through the pelvis and exit through the femoral neck, the mortality rate seen in patients with hip fractures being so high prior to present day interventions in hip reconstructive surgery. Figure 2 is a CT scan of the cervical spine. A skeletal face appears bracketed by C1. Figure 3 is a CT scan of the sacrum. A jack-o-lantern appears in the sacrum. 

Diagnosis: HAPPY HALLOWEEN – from the staff and radiologists at vRad! 

Halloween: Also known as all hallows eve or evening. 

All Hallows’ Eve was originally influenced by western European harvest festivals and festivals of the dead.

Halloween has been influenced by the Christian holy days of All Saints’ Day (also known as All Hallows, Hallowmas or Hallowtide) on November 1 and All Souls’ Day on November 2. They were a time for honoring the saints and praying for the recently departed who had yet to reach Heaven. All Saints was introduced in the year 609, but was originally celebrated on May 13. In 835, it was switched to November 1.

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Radiology case: Dense metaphyses and metaphyseal bands

Findings in this case: Figures 1 through 3. Figure one is of the RIGHT shoulder and figures 2 and 3 are of the LEFT wrist. The examination demonstrates abnormally dense metaphyses immediately adjacent to the physeal plate. Extending into the metaphyses are linear lines of calcific density. 

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Now available online for CME credit

Did you miss any of the live lectures from this year’s online CME series Practical Updates in Radiology from vRad Education? If you did, no problem! The recorder was running and the first four lectures are now available for CME credit online, anytime.

Register and take the recorded courses here.

Pelvic Trauma: Bone and Soft Tissue Imaging
Marc Camacho, MD, MS

Radiology of the Post-Breast Cancer Patient
Arlene Sussman, MD

Dead or Infected?  MRI Evaluation of Osteochondral Lesions and Osteomyelitis
Christine Lamoureux, MD

Landmarks of Cortical Neuroanatomy
Thomas Osborne, MD

Credit
Up to 2.0 AMA PRA Category 1 Credit(s)™ underwritten by the Arizona Health Sciences Center are available. Please review the technical requirements and guidelines on how to successfully complete the recorded courses for credit.

AMA PRA credit may only be claimed by, and awarded to, physicians who have completed an MD, DO or equivalent medical degree from another country.

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Radiology Case: Domestic violence

Figures 1 through 4. Figures 1 and 2. Axial images of the tissue bones demonstrating RIGHT orbital and maxillary sinus fractures. Note there is NO abnormality in the RIGHT maxillary sinus. NO associated contusion or edema in the soft tissues of the face. Fingers 3 and 4. Coronal reconstructions demonstrating acute fracture of the RIGHT mandible near the angle and of the LEFT anterior mandible.

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Radiology case: Medullary sponge kidney

 

Findings in this case: Figures 1 through 3. Figure 1. is a scout view of a CT scan of the abdomen. The open and closed arrows demonstrate calcifications projected over the renal outlines. Figure 2. is a coronal reconstruction of the CT scan of the abdomen. Figure 3. is a single slice through the level of the kidneys. Fingers 2. and 3. demonstrate multiple calcifications in the area of the renal collecting system.

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Radiology case: Unruptured splenic artery aneurysm

Findings in this case: Figures 1 -5. The examination is a CT scan of the abdomen with contrast. In the LEFT upper quadrant, associated with the distal 3rd of the splenic artery, there is an aneurysm. This is partially calcified. There is enhancement within in the aneurysm. This measures approximately 2.5 cm. There is NO evidence of rupture. NO abnormal stranding is demonstrated in the area around the aneurysm.

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Radiology case: Thornwaldt Cyst

Findings in this case: CT scan of the head with a focal low density in the posterior midline of the nasopharynx (arrow).

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Radiology Case: Bronchopulmonary dysplasia

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Radiology case: Maisonneuve fracture


Figure 1

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Radiology case: radial neck fracture

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Radiology case: Venous Angioma


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Radiology case: perforated appendicitis

History: RUQ Pain

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